| NPI | 1700839420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 5750) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 652) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-09-11 |